A presentation given to the QualityWatch 2015 annual conference by Dr Martin Bardsley, Director of Research, Nuffield Trust.

1. © Nuffield Trust and Health Foundation © Nuffield Trust© Nuffield Trust and Health Foundation
November 16, 2015
Closer to Critical?
Martin Bardsley Holly Dorning
Liz Fisher Lucia Kossorova
Ian Blunt (in absentia) Paul Smith

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Five year programme
• Independent view of changes in quality during a period
of financial constraint
• Using sets of indicators to measure changes in the
quality of care. (>300)
• Deeper analyses on specific topics (10)
• Annual overview report, conferences, seminars
• Website www.qualitywatch.org.uk charts, analysis,
blogs (thanks to Anna)

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Challenge of assessing quality…
Quality is multidimensional – does not easily fall into a handful
of simple indicators.
Quality will vary between areas where services are provided,
and vary over time
Danger of focussing in what's measured and missing the point
Time lag for change to work through the systems –good quality
care may not be immediately visible
Our ability to use information improving – look forward to new
and better metrics

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Uneven distribution of information

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In 2012/3 we noted…
Quality is complex to measure eg patients
Many indicators holding up…..but slackening
Urgent and emergency care – broader systems changes
Public health – actually doing ok …. Ish but fear for
preventive services

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Last year 2013/14
Some areas of improvement but major concerns about
• achievements on access targets
• Mental health services
• workforce – numbers and satisfaction

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This year
Not all ‘bad ‘ – positive efforts on a number of fronts
But increasing concerns around
- access –urgent and planned
- services for children
- workforce
Ambulance and mental health services a particular
concern

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Measures of access to services are declining eg people are spending
longer in Accident & Emergency (A&E) and experiencing delays to
planned treatment

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Mental health and ambulance services appear
consistently throughout the themes we highlight this year

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Children
• There are positive signs for the prevention of harm in
the general population of children and young people eg
vaccination, conceptions rates, alcohol
• upward trend in the proportion of children aged 10–11
classed as obese, from 17.5 per cent to 19.1 per cent
• combined rate of admissions for diabetes, asthma, and
epilepsy and convulsions in people under 19. While
fluctuating, this rate has been falling
• problems with the whole system of children and
adolescent mental health services and waiting times
for outpatient CAMHS have increased

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Health related behaviour - teenage conception rates

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Discrepancy between the completeness of the care
received by adults compared with children

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Staffing and workforce
• % NHS staff reporting that they had been ill due to
work-related stress was at its highest since the survey
began at 38 per cent
• Around one quarter of NHS staff (22 per cent) reported
having experienced harassment, bullying or abuse from
their managers or other colleagues
• In domiciliary care, around 31 per cent of staff leave
their jobs each year (Skills for Care, 2014),

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Staffing levels
High vacancy rates eg
• Vacancy rates at 10 per cent of the total
paramedic workforce
• 8% of organisations having between 100-250 fte
nurse vacancies
Spending on contract and agency staff increasing to £3.3
billion – around 7 per cent of all NHS staff costs
Staff turnover - More than two thirds of NHS staff (71 per
cent) report working extra hours unpaid.

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More than two thirds of NHS staff (71 per cent) report working
extra hours unpaid.

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What does the future hold?
The tensions between financial constraints and quality
Opportunities for new organisational models
Leadership, support for improvement and regulation

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© Nuffield Trust and Health Foundation
November 16, 2015
martin.bardsley@nuffieldtrust.org.uk